New HIV infections among Singapore residents fall to lowest level since 1998

SINGAPORE: A total of 202 new human immunodeficiency virus (HIV) cases were reported among Singapore residents last year, according to data released by the Ministry of Health (MOH) in June 2023.

The number of new HIV infections has fallen for the third year in a row and is the lowest reported since 1998, when there were 199 cases.

There were 250 new cases of HIV infections in 2021, 261 in 2020, and 323 in 2019.

Among the cases in 2022, slightly more than half had late-stage HIV infection when they were diagnosed.

Eighteen per cent of the cases were detected during routine HIV screening, while 17 per cent were detected from self-initiated HIV screening. The latter tended to be at the early stage of infection, said MOH.

Most of the 2022 cases involved men, with 187 diagnosed with HIV.

A higher proportion of men who have sex with men – including bisexual males – found out about their HIV infection through self-initiated screening, compared with men who have sex with women.

Sexual intercourse remained the main mode of transmission, making up about 93 per cent of cases in 2022.

Men who have sex with men accounted for about half of the cases, while men who have sex with women accounted for around 37 per cent. About 4 per cent of the cases were due to bisexual transmission.

Three cases occurred due to intravenous drug use.

As of end-2022, the total number of HIV-infected Singapore residents stood at 9,331, of whom 2,362 had died.

The annual number of new cases ranged from 400 to 500 between 2007 to 2017, before gradually decreasing to fewer than 300 cases in the last three years.

GET TESTED AT LEAST ONCE: MOH

In a public advisory, MOH and the Health Promotion Board urged people who engage in high-risk sexual behaviour to go for regular HIV testing every three to six months.

MOH noted that everyone should know their HIV status and get tested at least once. Those living with HIV can achieve better treatment outcomes if they are diagnosed at an early stage, it added.

“This also provides an opportunity to protect their partners from infection as persons living with HIV who are on treatment and have an undetectable viral load have practically no risk of transmitting the virus to their sexual partners,” said MOH.

“With early and effective treatment, people living with HIV can lead lives no different from others.”

The ministry added that the most effective way to prevent HIV infection was to remain faithful to one’s spouse or partner, as well as to avoid casual sex or engage in sexual activities with sex workers.

RECOMMENDATIONS BY NATIONAL HIV PROGRAMME

Separately, a team of doctors from the National HIV Programme has recently developed a set of recommendations for more people to voluntarily get tested and catch infections earlier.

These recommendations were published last month in a review article in the Singapore Medical Journal.

The National HIV Programme is run by the respective clinical HIV programmes under the National Centre for Infectious Diseases, National University Hospital, Singapore General Hospital and Changi General Hospital.

The doctors recommended that all those aged above 21 - except females above 65 - should be offered HIV screening at least once in their lifetime, unless they have risk factors that warrant repeated screening.

Those who engage in high-risk behaviour, such as those with a history of injection drug use or those with multiple sex partners, should also be screened for HIV at least once a year, they said.

For high-risk individuals who are being tested for the first time, or do not have sufficient education on the implications of an HIV test, the doctors said pre-test counselling is strongly encouraged.

HIV testing is traditionally performed at hospitals, clinics and through services provided by community-based organisations. Several, including local non-profit organisation Action for AIDS, offer anonymous testing.

The doctors also recommended that healthcare and HIV testing service providers encourage individuals to disclose their HIV status to their spouse, current sex partners and previous sex partners. They should also be encouraged to get tested.

Positive HIV results should be told confidentially and in person by physicians or other skilled staff due to the risk of discrimination and stigma, the doctors added.

In their article, they pointed to the “95-95-95” targets set by the Joint United Nations Programme on HIV/AIDS in a bid to end the epidemic.

These targets are getting 95 per cent of all people living with HIV to be aware of their diagnosis by 2030; 95 per cent of those diagnosed to receive sustained antiretroviral therapy; and 95 per cent of those receiving antiretroviral therapy to achieve viral suppression.

The doctors noted that estimates based on data from 2020 indicate that 82 per cent of people in Singapore who have HIV infection know their status; 93 per cent of those who are aware of their status are on antiretroviral therapy; and 94 per cent of those on therapy have sustained viral suppression.

“Hence, more can be done to increase the uptake of voluntary HIV testing with a view to reduce the number of late‐stage infections at diagnosis,” they wrote.

"Early detection of infection allows earlier initiation of antiretroviral therapy, which reduces the risk of developing serious AIDS‐related events, serious non‐AIDS deaths or deaths by at least 50 per cent.” 

HIV attacks the body’s immune system, specifically its white blood cells. There is no cure but with treatment, an HIV-positive individual can maintain an undetectable viral load.

This means there is effectively zero risk of transmitting HIV to their sexual partner, even if they do not use condoms during penetrative sex.

HIV-positive individuals who do not get treated can develop AIDS (acquired immunodeficiency syndrome), which is potentially fatal. This typically takes anywhere between five to 10 years.

Other than unprotected sex, a person can contract HIV by sharing injection equipment, contaminated blood transfusions and organ or tissue transplants. It can also be passed from a mother to her unborn child.

Those who want to learn more about HIV and AIDS, and find out where to get HIV testing, can go to go.gov.sg/preventhiv.